Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system

Bingham, Gordon, Fossum, Mariann, Barratt, Macey and Bucknall, Tracey 2015, Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system, Critical care and resuscitation, vol. 17, no. 3, pp. 167-173.

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Title Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system
Author(s) Bingham, Gordon
Fossum, Mariann
Barratt, Macey
Bucknall, TraceyORCID iD for Bucknall, Tracey orcid.org/0000-0001-9089-3583
Journal name Critical care and resuscitation
Volume number 17
Issue number 3
Start page 167
End page 173
Total pages 7
Publisher College of Intensive Care Medicine of Australia and New Zealand
Place of publication Bedford Park, S.A.
Publication date 2015-09
ISSN 1441-2772
Keyword(s) Adult
Aged
Australia
Critical Care
Cross-Sectional Studies
Female
Hospital Mortality
Hospital Rapid Response Team
Humans
Length of Stay
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Selection
Retrospective Studies
Summary OBJECTIVES: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. MAIN OUTCOME MEASURES: Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. RESULTS: Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P < 0.001). CONCLUSIONS: About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.
Language eng
Field of Research 111002 Clinical Nursing: Primary (Preventative)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2015, College of Intensive Care Medicine of Australia and New Zealand
Persistent URL http://hdl.handle.net/10536/DRO/DU:30078536

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